NCEPOD: Trauma - Who Cares? - London Health Programmes

CHAPTER 6 - Airway and breathingFigure 23. First ABG PaCO 2measurements350300Number of patients250200150100500≤ 3 > 3 ≤ 4 > 4 ≤ 5 > 5 ≤ 6 > 6 ≤ 7 > 7 ≤ 8 > 8 ≤ 9 > 9 NotrecordedPaCO 2 (kPa)One of the challenges in the trauma patient can be provisionof an adequate airway 9 and tracheal intubation is frequentlya much more diffi cult procedure in the trauma patient 10 .Table 54 shows that in 56/753 (7.4%) cases, the advisorssaw evidence of diffi culty in obtaining an adequate airway.In 42 cases it was not possible to assess this. Of interest waswhether this was associated with the grade or experienceof personnel involved. Unfortunately, the information on thepersonnel involved was so poorly documented, thatno comment can be made on this relationship.Table 54. Evidence of difficulty in obtaining an airwayNumber of patients %Yes 56 7.4No 697 92.6Subtotal 753Insuffi cient data 42Total 795The group of patients who are diffi cult to intubate may havedifferent injuries, or a greater severity of injury, compared tothe group in whom there was no diffi culty with intubation.The mortality rate at 72 hours in the group of patients withairway diffi culty was 25% (14/56) compared with 13.6%(95/697) in the non-diffi cult group. However, it is not clear ifthere was any direct causal relationship between the diffi cultywith airway provision and mortality.Advisors were asked to make an overall assessment of themanagement of the airway and breathing. From Table 55it can be seen that this was considered unsatisfactory in52/741 cases (7%) where the data could be assessed.Table 55. Satisfactory airway managementNumber of patients %Yes 689 93.0No 52 7.0Subtotal 741Insuffi cient data 54Total 79566